A new edge to the fight against tuberculosis | 21st April 2023 | UPSC Daily Editorial Analysis

What's the article about?

• It talks about the measures that are required to address the issues of tuberculosis in India.

Relevance:

• GS2: Issues Relating to Development and Management of Social Sector/Services relating to Health, Education, Human Resources;
• Prelims

Context:

• More than 26% of Global TB cases are from India. India experienced a 19% increase in TB cases in 2021 compared to the previous year.
• At the One World TB Summit in Varanasi, Uttar Pradesh on March 24, 2023, Prime Minister instilled fresh energy to the global tuberculosis (TB) elimination response and reiterated India’s commitment to spearhead this effort.

What is Tuberculosis (TB)?

• It  is an infectious disease caused by the bacteria Mycobacterium Tuberculosis.
• It generally affects the lungs but can impact other parts of the body.
• TB is of two types:
  • Latent TB: It is when the infections do not show any symptoms which is the case most of the time.
  • Active TB: It is when the infections show visible symptoms such as chronic cough with blood in mucus, fever, night sweats, and weight loss.
• TB is spread from person to person through the air which makes it highly contagious. But people with latent TB do not spread the disease.

Analysis:

• The COVID-19 Success:
  • The COVID-19 pandemic provides a good reflection point — even with innumerable challenges, countries were able to counter COVID-19 by drawing upon the innate human spirit to adapt, learn, experiment, and innovate.
  • The pandemic has shown us that together, we can overcome unprecedented adversity. And if we could do it to overcome COVID-19, we can, and must certainly, do it to end TB.
  • The Mission COVID Suraksha programme to develop vaccines was a good example of a public-private partnership, with clear goals and outcomes.
  • The huge number of diagnostic tests developed and a variety of different vaccine platforms show that our manufacturing sector is robust and can scale rapidly.
• India’s efforts to contain and eliminate TB in India:
  • India’s National TB Elimination Programme (previously known as the Revised National Tuberculosis Control Programme): introduced several measures to find, notify and treat TB cases.
  • Improved TB management: novel approaches including engagement with the private sector, launch of social support provisions and introduction of diagnostic tools and new drug regimens.
• More needs to be done:
  • Lack of widespread awareness about the disease and lack of access to quality care continue to be a challenge.
  • The recent National TB Prevalence Survey (in India) found that 64% of people with infectious TB did not seek care. As a result, national-level estimates suggest that for every person notified with TB, we miss detecting almost two more cases.
• Suggestions:
  • Development of vaccines:
    • For any infectious disease, a vaccine is what makes elimination possible. Present Bacille Calmette-Guérin (BCG) vaccine does not adequately protect adolescents and adults who are at the highest risk for developing and spreading TB.
    • There are currently over 15 TB vaccine candidates in the pipeline; we must ensure that their clinical trials are prioritised to assess their efficacy in various community settings and for different target groups.

  • BCG Vaccine: BCG was developed by two Frenchmen, Albert Calmette and Camille Guerin, by modifying a strain of Mycobacterium bovis (that causes TB in cattle). It was first used in humans in 1921. In India, BCG was first introduced in a limited scale in 1948 and became a part of the National TB Control Programme in 1962. In addition to its primary use as a vaccine against TB, it protects against respiratory and bacterial infections of the newborns, and other mycobacterial diseases like Leprosy and Buruli’s ulcer. One intriguing fact about BCG is that it works well in some geographic locations and not so well in others. Generally, the farther a country is from the equator, the higher is the efficiency.

  • Accessible and affordable testing and diagnosing:
    • Each person with suggestive symptoms or frontline worker can test and get results within minutes, at minimal costs.
    • Point-of-Care Tests (POCTs), such as home-based tests, nasal and tongue swab-based tests and handheld digital x-ray machines need to be promoted.
  • Development and introduction of new therapeutic molecules:
    • While we continue to invest in drug discovery, we must also scale up newer and more effective regimens and also dip into our armoury to re-purpose existing drugs for TB.
  • Creating regulatory and policy frameworks that smoothen the rollout of proven tools to reach people with as little delay as possible.
    • Harmonisation of standards and regulatory processes between countries can enable mutual recognition of evidence-based standards and licences and save critical time towards rollout.

Way Forward:

• The COVID-19 pandemic proved India’s apt title: pharmacy of the world. Our scientific ingenuity during the pandemic has cemented our position as pioneers in innovation in the life sciences.
• In this spirit, we must create a strong platform that channelises investments in research to bring in a paradigm shift at every stage of the TB care cascade — prevention, testing, and treatment.
• With its G-20 presidency, India has another historical opportunity to build a global health architecture that creates equitable access for all.